B-Zell-Depletion mit Rituximab als neuer therapeutischer Ansatz bei Kollagenosen und Vaskulitiden

Zusammenfassung

Die B-Zell-depletierende Wirkung des Anti-CD20-Antikörpers Rituximab wird seit Ende der 90er-Jahre erfolgreich zur Behandlung bestimmter Non-Hodgkin-Lymphome genutzt und seit einigen Jahren auch bei gegen Standardtherapie resistenter rheumatoider Arthritis. In jüngster Zeit findet Rituximab aber auch zunehmend Eingang in die Therapie von Kollagenosen und Vaskulitiden, also von Autoimmunkrankheiten, in deren Pathogenese die Bedeutung von B-Zellen bisher widersprüchlich diskutiert wurde. Die vorliegende Arbeit gibt einen umfassenden Überblick der bislang publizierten Studienergebnisse und Fallberichte zur Rituximabbehandlung von Patienten mit systemischem Lupus erythematodes, primärem Sjögren-Syndrom, Vaskulitiden, Dermatomyositis, Polymyositis und systemischer Sklerose. Berücksichtigt man, dass diese Patienten zuvor mehrheitlich schwere, therapierefraktäre Verläufe gezeigt hatten, muss man die bisherigen Behandlungsergebnisse mit Rituximab als äußerst vielversprechend bewerten.

Abstract

The anti-CD20 antibody rituximab is a B-cell depleting agent commonly used since the late 1990s to treat selected non-Hodgkin lymphomas and, more recently, rheumatoid arthritis refractory to disease-modifying antirheumatic drugs and anti-TNF-alpha therapy. Furthermore, during the past few years rituximab has been increasingly used for the treatment of connective tissue diseases and vasculitides, i. e., autoimmune diseases with a still elusive pathogenetic link to B cells. This review provides a complete summary of the published studies and case reports of rituximab in the treatment of patients with systemic lupus erythematosus, primary Sjögren’s syndrome, vasculitides including Wegener’s granulomatosis, microscopic polyarteriitis, and Churg-Strauss syndrome, dermatomyositis, polymyositis, and systemic sclerosis. Given that most of these patients had severe, treatment-refractory disease, the good responses to rituximab seen in the majority of patients appear particularly promising.

Schlüsselwörter

B-Zell-Depletion - Kollagenosen - Vaskulitiden

Key words

B cell depletion - connective tissue diseases - vasculitides

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